Tuesday, December 12, 2006

Can the VERB™ Campaign increase activity and exercise in America’s youth?: A social and behavioral sciences critique- Allison Beatty

The problem of obesity in the United States has grown to epidemic proportions. Men and women of all ages are big and getting bigger. By the end of 2004, 17.1% of all children and adolescents ages 2-19 were overweight. This statistic has been steadily rising for the past five years and shows no signs of stopping.(1)
To help combat this problem, the CDC has developed a series of behavioral health improvement campaigns to specifically target youth. One program, the youth media campaign called VERB™, aims at preventing obesity through the promotion of and education about daily activity and exercise. The VERB™ campaign is an educational program that uses informative fliers, posters, games, interactive web-sites and radio, TV, and print commercials to convey its message to youths and adult influencers. (http://www.cdc.gov/youthcampaign/) The program is free to anyone with internet access.

Unfortunately, I believe the campaign’s effectiveness will be limited over time. I believe it lacks sustainable elements necessary for an effective intervention among a wide spectrum of youth, especially urban, inner-city youth at high risk for obesity. Though well intentioned, the VERB™ campaign lacks both environmental and overall diversity awareness in its delivery of health messages and health motivation. The campaign does not address many environmental and social factors which influence activity patterns of youth living in inner-city environments.
To its credit, the VERB™ campaign segments its promotional materials in to a variety of racial categories. Separate commercials feature Asian, Hispanic, Caucasian, Black and multi-racial actors. Children and adult influencers of these ethnic backgrounds are depicted delivering messages and modeling behavior throughout its content. Unfortunately, VERB™ fails to recognize that there are other important differences between children beyond their ethnicity or race.

Why the VERB campaign is NOT Accessible to ALL youth
The program operates on two major assumptions which have clearly informed and molded its content. First, the program assumes that most children will be interested in activities that are competitive, and that children of a certain race/ethnicity all like very particular genres of sports. Second, it assumes that all children will have access to safe, encouraging areas of play.

Problem #1: All Children Fit into Certain Boxes
Many if not most of the activities presented in the VERB™ campaign materials are games where kids compete with one another, often with rewards for the winners, and nothing for the losers. Additionally, these competitive games appear to be sub-categorized base upon the intended ethnic/racial audience- (i.e., one target audience, one or two types of games portrayed by kids and adult influencers.) Several problems stem from this narrow approach to youth activity. Common sense tells us that a spectrum of interest and competitiveness exists throughout children, regardless of race. Many children are not interested in competition as a part of every activity they do. Not every child has natural athletic ability that will enable him or her to enjoy competition if the only outcome that is rewarded is winning. Additionally, many children are not necessarily interested in one or two types of “ethnic specific” activities. For instance, if you are African-American and are exposed to the African-American materials, but do not like basketball or football, there are few alternative activities presented in the advertising materials with which you might self-identify. This is of major concern considering the disparity between levels of obesity among minority-ethnic groups and non-minority ethnic groups.(7) Basic social psychological principles tell us that children who do not see themselves as competitors or who are not interested in their “ethnically oriented” activities will not readily identify with the VERB™ messages and reject them.

The theory of self-efficacy tells us that the “belief in one’s capabilities to organize and execute the courses of action required to manage prospective situations” will drive one’s actions. (2) The children that do not believe they can “organize and execute the necessary skills” to compete in the actions depicted will necessarily be less likely to do such activities. For the campaign to be universally effective it must provide alternative activities that do not necessitate skill levels associated with competing and/or winning, in proportion to the number of children with which such activities resonate. There is a growing body of evidence to suggest that placing children in environments that do not fit their competitive personality types yield poor to average results at best. (3, 4) For the VERB™ campaign to increase its effectiveness, it must take a broader view of physical activity. It must portray activities that appeal to a wide range of skill levels and competitive personality types.

Problem #2: All Children have Access to Safe Areas of Play
Overwhelmingly the campaign materials depict children participating in activities in well maintained recreation facilities or fields. To the casual observer, these environments are reminiscent of many suburban sports complexes- rare finds in a urban or rural setting. This is particularly concerning considering that “low-income, racial/ethnic minority, and rural populations are less physically active and more overweight and obese.” (5) Using environments dissimilar to their own make children who view these messages more likely to reject them because the situations are not representative of their own environment.
Additionally, most youth do not have control of their own environment, but must make activity choices based on their surroundings. Even if the VERB™ messages were to depict urban or rural settings, children may not be able to translate their intentions into action. Once children are no longer in a school or community center, (after school for example) that provides play fields, safe meeting places, and or adult supervision, they will be less likely to continue the physical activities they see being portrayed.(6) Given the decrease in time allotted to physical education during school, children must make up their physical activity after they are done with school for the day.
So where should these kids go? The literature suggests that low SES, high minority groups living in urban environments are more likely to access activity and recreation centers than their higher SES, non-minority counterparts. Unfortunately and ironically, the literature also suggests that lower SES and high-minority groups are less likely to have access to these facilities than their higher SES and non-minority counterparts. (7)

Now What? Discussing the Options
To be fair, studies have shown that the VERB™ campaign has succeeded in raising awareness about activity and the need for increased exercise in youth as well as raising activity level in certain sub-groups.(8) However, without addressing the above concerns, the increased awareness and activity levels will likely stagnate and stay siloed within the particular sub-groups. Campaign success must be measured by a rise in activity levels for all populations exposed, not just certain sub-groups.

Increase Available Facilities
As pointed out by Nelson et. al, those with better access to recreation facilities are more likely to use them. Instead of paying an incredible marketing firm incredible marketing firm fees, use funds to make recreation facilities more widely available! (9) Use them to pay after-school preceptors for school play areas. Use them to support and increase the number of local rec centers. Not only will supporting or increasing the number of rec centers help kids become active now, it enables youth to be active beyond their teens into adulthood!

Make PE a Priority!
Put the money toward physical education classes! Many studies show that Physical Education classes significantly increase physical activity when provided during the school day.(10) Trends in America show funding and priority for physical education in schools is dropping. This trend must be reversed!

Variety is the Spice of Life
Show a variety of activities to every audience. When kids are given alternatives, it enables them to make choices that they are confident that they can accomplish! Ensure that a variety of activities, not just those that are competitive, are modeled for all children. Continue to show role models of a variety of backgrounds, but do it in a manner that shows it is OK to walk or hike or be active on one’s own. Being physically health and active means so much more than just ringing up points on a score board.

The CDC and National Institutes of Health have come a long way in their efforts to help Americans lead healthier, more active lives. Increasing awareness about the benefits of being active serves as a great starting point for the call to action. Going forward, efforts must be focused on building a supportive and encouraging environment for more citizens to be active in their everyday lives. Luckily, awareness of a few social science principles will help successfully inform and direct those efforts so that America’s new growth is in a healthy direction.

1. Ogden CL, Carroll MD, et. al. Prevalence of Overweight and Obesity in the United States, 1999-2004, JAMA. 2006;295:1549-1555.
2. (http://www.des.emory.edu/mfp/efficacy.html)
3. Schneider S, Mohnen SM, Tonges S, Potschke-Langer M, Schulze A. Are competitions an appropriate instrument for youth smoking cessation? A 1-year follow-up of the Germany-wide "Smoke-free 2004" campaign] Med Klin (Munich). 2006 Sep 15;101(9):711-7.
4. Lam SF, Yim PS, Law JS, Cheung RW. The effects of competition on achievement motivation in Chinese classrooms. Br J Educ Psychol. 2004 Jun;74(Pt 2):281-96.
5. Gordon-Larsen P, Adair LS, Nelson MC, Popkin BM. Five-year obesity incidence in the transition period between adolescence and adulthood: the National Longitudinal Study of Adolescent Health. Am J Clin Nutr 2004;80:569 –75.
6. Giles-Corti B, Donovan RJ. Socioeconomic status differences in recreational physical activity levels and real and perceived access to a supportive physical environment. Prev Med. 2002 Dec;35(6):601-11.
7. Gordon-Larsen P, Nelson MC, Page P, Popkin BM. Inequality in the built environment underlies key health disparities in physical activity and obesity. Pediatrics. 2006 Feb;117(2):417-24.
8. Huhman M, Potter LD, et al. Effects of a mass media campaign to increase physical activity among children: year-1 results of the VERB campaign. Pediatrics. 2005 Aug;116(2):e277-84.
9. Nelson MC, Gordon-Larsen P, Song Y, Popkin BM. Built and social environments associations with adolescent overweight and activity. Am J Prev Med. 2006 Aug;31(2):109-17.
10. Gordon-Larsen P, McMurray RG, Popkin BM, Determinants of Adolescent Physical Activity and Inactivity Patterns PEDIATRICS Vol. 105 No. 6 June 2000, p. e83


Anonymous Anonymous said...

The recognition that children need choices in activities and exercise is very important. I think programs that expand the exposure to many types of activities is a wonderful way to help children find a way to stay active and be excited about it.

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The U.K new Government Accountability Office (GAO) literature review of 53 articles on childhood obesity and factors affecting levels of physical activity reinforces the need for schools to have Coordinated School Health Programs (CSHP) to help decrease obesity among children and youth. http://www.phentermine-effects.com

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